Cardiovascular manifestations and treatment considerations in COVID-19

Abstract

Since its recognition in December 2019, covid-19 has rapidly spread globally causing a pandemic. Pre-existing comorbidities such as hypertension, diabetes, and cardiovascular disease are associated with a greater severity and higher fatality rate of covid-19. Furthermore, COVID-19 contributes to cardiovascular complications, including acute myocardial injury as a result of acute coronary syndrome, myocarditis, stress-cardiomyopathy, arrhythmias, cardiogenic shock, and cardiac arrest. The cardiovascular interactions of COVID-19 have similarities to that of severe acute respiratory syndrome, Middle East respiratory syndrome and influenza. Specific cardiovascular considerations are also necessary in supportive treatment with anticoagulation, the continued use of renin-angiotensin-aldosterone system inhibitors, arrhythmia monitoring, immunosuppression or modulation, and mechanical circulatory support.

Keywords: cardiac risk factors and prevention; myocarditis; systemic inflammatory diseases.

Figure 1

Influence of cardiovascular and other comorbidities on CFR from respiratory viral infections. CDC, Center for Disease Control and Prevention; CFR, case fatality rate; MERS, Middle East respiratory syndrome; SARS, severe acute respiratory syndrome. Data are from Chinese CDC, Mertz et al, Chan et al and Badawi et al.

Figure 2

Possible mechanisms of cardiovascular injury due to COVID-19. DIC, disseminated intravascular coagulation; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.